Strategies for Addressing Recurrent Pregnancy Loss (Virtual Symposium)-HANDOUT: 04-Roberts-Decoding_the

HANDOUT: 04-Roberts-Decoding_the_Placenta

Pdf Summary

This presentation by Dr. Drucilla J. Roberts highlights the critical clinical significance of placental pathology in obstetrics and neonatology. Placental pathological examination provides valuable insights, including auditing antenatal clinical management, identifying causes of adverse pregnancy outcomes, guiding management of future pregnancies, detecting conditions requiring urgent intervention, understanding factors leading to neonatal morbidity or long-term diseases, aiding medicolegal resolution, and improving maternal health outcomes.<br /><br />Key maternal findings include timing and severity assessment of causative pathology in maternal mortality, detection of cardiovascular disease risk, metastatic malignancies, and recurrent pregnancy conditions. For fetal/neonatal outcomes, placental pathology often identifies the etiology of pregnancy loss, diagnoses specific infections, and determines timing and causes of hypoxic ischemic encephalopathy or fetal stroke.<br /><br />Several illustrative cases and pathological entities were discussed:<br /><br />- Placental mesenchymal dysplasia, associated in some cases with Beckwith-Wiedemann Syndrome (BWS), which involves macrosomia and predisposition to pediatric tumors.<br />- Adherent myometrial fibers in the placenta can predict increased risk of morbidly adherent placenta (placenta accreta spectrum) in future pregnancies, necessitating heightened surveillance.<br />- Placental findings related to congenital embolic stroke and fetal inflammatory response secondary to chorioamnionitis highlight placental contributions to neonatal neurologic injury.<br />- Cytomegalovirus placentitis with chronic villitis and associated neonatal complications prompts antiviral treatment and developmental monitoring.<br />- Acute chorioamnionitis histology correlates with neonatal infection and poorer neurodevelopmental outcomes.<br />- Meconium-associated myonecrosis is a toxic placental injury linked to poor neurological outcomes including cerebral palsy.<br />- Placental examination can identify inborn errors of metabolism and malignancies, including rare primary placental choriocarcinoma or metastatic maternal cancers, which have major prognostic and treatment implications for mother and infant.<br /><br />The presentation emphasizes the necessity to communicate critical placental pathology findings to clinicians for immediate or future patient management, underscores established criteria for placenta examination, and advocates multidisciplinary collaboration. Overall, recognizing specific placental lesions provides essential diagnostic, prognostic, and therapeutic benefits for families, obstetricians, neonatologists, and pediatricians, ultimately improving pregnancy outcomes and guiding clinical care across generations.

Keywords

placental pathology

obstetrics

neonatology

adverse pregnancy outcomes

placenta accreta spectrum

chorioamnionitis

hypoxic ischemic encephalopathy

Beckwith-Wiedemann Syndrome

cytomegalovirus placentitis

neonatal neurologic injury